Industry Voices—Medicare takes key steps to treat more patients at home amid COVID-19 crisis

Respiratory suppliers will play a critical role in caring for patients at home, including those who have tested positive for COVID-19. (Getty/ozgurkeser)

As the COVID-19 disease pandemic advances rapidly, the U.S. is taking extreme measures to mitigate the health impact of the virus.

From statewide stay-at-home orders to invocations of the Defense Production Act to ensure an adequate supply of personal protective equipment (PPE) for the nation’s healthcare workers, Americans are steeling themselves for a long, drawn-out war against this virus. 

To effectively confront the once-in-a-generation challenge that lies ahead, we must learn from the experiences of other countries grappling with the crisis, most notably Italy.

Many Italian physicians on the frontlines have reached a simple yet decisive conclusion: treating patients at home is critical to blunt the impact of hospital surges and minimize the risk of further disease transmission.

Among the key lessons from Italy’s coronavirus experience is the risk of hospitals and outpatient care settings becoming overwhelmed with COVID-19 cases while also serving as breeding grounds for further disease transmission and infection. 

Already facing severe shortages of beds, ventilators, and PPE, Italian hospital staff are also fighting to ensure those infected with the virus are not indirectly transmitting the infection to other patients and healthcare professionals. To mitigate these risks, doctors are voicing support for home respiratory treatment and care. By treating patients at home and ensuring the adequate supply of home oxygen and other respiratory therapies and supplies, home respiratory therapy is a key pillar in Italy’s fight against COVID-19.

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Informed by the experiences of our overseas colleagues, respiratory suppliers will play a critical role in caring for patients at home, including those who have tested positive for COVID-19. Those suppliers are ready to serve as a “second line of defense” to help ease the overwhelmingly heavy burden on hospitals by moving quickly to transition eligible patients from crowded hospital wards to the home setting. But they cannot take on this fight alone.

Fortunately, through a spate of recently announced actions, Congress and the administration are working to ensure we have the support needed to do this.

The Centers for Medicare & Medicaid Services (CMS) loosened key regulatory requirements that would otherwise companies' ability to deliver home respiratory services during the COVID-19 crisis. Notably, the administration reduced administrative burdens and staggering paperwork requirements, giving us much-needed flexibility to properly respond quickly to the national emergency.

Along with suspending medical record reviews that consume provider time and resources, the administration also relaxed proof of delivery requirements in which patients, many of whom suffer from debilitating illnesses, would have been required to personally sign documents upon delivery of their home respiratory equipment.

Given that vulnerable patients are understandably worried about exposing themselves to the virus through face-to-face contact, the temporary suspension of this requirement is a critical step that prioritizes patient safety. Similar policies have already been implemented in Italy and Germany and it’s good to see our government follow suit.

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Perhaps more importantly, the Trump administration now permits Medicare to reimburse for the home respiratory care provided to patients with acute conditions—including COVID-19 and pneumonia. While Medicare previously only covered services for patients with chronic illness, this change will allow more patients to be treated safely in their homes, something that will help free up hospital beds and provide much-needed relief for frontline healthcare workers. 

Despite this important progress, policymakers must do more to ensure patients can receive the respiratory care they need in their homes.

First, suppliers must have greater access to PPE to protect them and patients from potential coronavirus transmissions. Second, before the onset of the present health crisis, Medicare rolled out a flawed, complex competitive bidding program that will stifle reimbursement rates for suppliers and force them to exit markets across the country. Implementing policies that reduce the number of respiratory suppliers at a time of unprecedented need is dangerously counterproductive.

Therefore, CMS should pause the program until we can better understand the full impact of the COVID-19 emergency.

Given the urgency of this national crisis, I’m glad leaders in Washington are learning from the experiences of our European colleagues and are moving quickly to support home respiratory care providers in their continued mission to serve vulnerable patient populations.

While other concerns remain, most notably PPE and an anticipated decline in suppliers due to Medicare’s new payment system, I have confidence these issues can be resolved in the coming weeks. I applaud Congress and the administration for empowering this sector to be part of the solution in overcoming this public health emergency.

Crispin Teufel is the chief executive officer of Lincare Inc., a member of the Council for Quality Respiratory Care.

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